The Eating Disordered Patient Eating disorders - notably Anorexia Nervosa and Bulimia Nervosa - are complex phenomena. The patient with eating disorder maintains a distorted view of her body as too fat or as somehow defective (she may have a body dysmorphic disorder).
Many patients with eating disorders are found in professions where body form and image are emphasized (e.g., ballet students, fashion models, actors).
The Diagnostic and Statistical Manual (DSM) IV-TR (2000) (pp. 584-5):
"(Patients with personality disorders exhibit) feelings of ineffectiveness, a strong need to control one's environment, inflexible thinking, limited social spontaneity, perfectionism, and overly restrained initiative and emotional expression ... (Bulimics show a greater tendency to have) impulse-control problems, abuse alcohol or other drugs, exhibit mood lability, (have) a greater frequency of suicide attempts.
" Eating Disorders and Self-control The current view of orthodoxy is that the eating disordered patient is attempting to reassert control over her life by ritually regulating her food intake and her body weight. In this respect, eating disorders resemble obsessive-compulsive disorders.
One of the first scholars to have studied eating disorders, Bruch, described the patient's state of mind as "a struggle for control, for a sense of identity and effectiveness.
"(1962, 1974).
In Bulimia Nervosa, protracted episodes of fasting and purging (induced vomiting and the abuse of laxatives and diuretics) are precipitated by stress (usually fear of social situations akin to Social Phobia) and the breakdown of self-imposed dietary rules. Thus, eating disorders seem to be life-long attempts to relieve anxiety. Ironically, binging and purging render the patient even more anxious and provoke in her overwhelming self-loathing and guilt.
Eating disorders involve masochism.
The patient tortures herself and inflicts on her body great harm by ascetically abstaining from food or by purging. Many patients cook elaborate meals for others and then refrain from consuming the dishes they had just prepared, perhaps as a sort of "self-punishment" or "spiritual purging.
" The Diagnostic and Statistical Manual (DSM) IV-TR (2000) (p. 584) comments on the inner mental landscape of patients with eating disorders:
"Weight loss is viewed as an impressive achievement, a sign of extraordinary self-discipline, whereas weight gain is perceived as an unacceptable failure of self-control.
" But the "eating disorder as an exercise in self-control" hypothesis may be overstated. If it were true, we would have expected eating disorders to be prevalent among minorities and the lower classes - people whose lives are controlled by others. Yet, the clinical picture is reversed: the vast majority of patients with eating disorders (90-95%) are white, young (mostly adolescent) women from the middle and upper classes. Eating disorders are rare among the lower and working classes, and among minorities, and non-Western societies and cultures.
Refusing to Grow Up Other scholars believe that the patient with eating disorder refuses to grow up. By changing her body and stopping her menstruation (a condition known as amenorrhea), the patient regresses to childhood and avoids the challenges of adulthood (loneliness, interpersonal relationships, sex, holding a job, and childrearing).
Similarities with Personality Disorders Patients with eating disorders maintain great secrecy about their condition, not unlike narcissists or paranoids, for instance. When they do attend psychotherapy it is usually owing to tangential problems: having been caught stealing food and other forms of antisocial behavior, such as rage attacks.
Clinicians who are not trained to diagnose the subtle and deceptive signs and symptoms of eating disorders often misdiagnose them as personality disorders or as mood or affective or anxiety disorders
Patients with eating disorders are emotionally labile, frequently suffer from depression, are socially withdrawn, lack sexual interest, and are irritable. Their self-esteem is low, their sense of self-worth fluctuating, they are perfectionists. The patient with eating disorder derives narcissistic supply from the praise she garners for having gone down in weight and the way she looks post-dieting. Small wonder eating disorders are often misdiagnosed as personality disorders: Borderline, Schizoid, Avoidant, Antisocial or Narcissistic.
Patients with eating disorders also resemble subjects with personality disorders in that they have primitive defense mechanisms, most notably splitting.
The Review of General Psychiatry (p. 356):
"Individuals with Anorexia Nervosa tend to view themselves in terms of absolute and polar opposites. Behavior is either all good or all bad; a decision is either completely right or completely wrong; one is either absolutely in control or totally out of control.
" They are unable to differentiate their feelings and needs from those of others, adds the author.
To add confusion, both types of patients - with eating disorders and personality disorders - share an identically dysfunctional family background. Munchin et al. described it thus (1978): "enmeshment, over-protectiveness, rigidity, lack of conflict resolution.
"Both types of patients are reluctant to seek help.
The Diagnostic and Statistical Manual (DSM) IV-TR (2000) (pp. 584-5):
"Individuals with Anorexia Nervosa frequently lack insight into or have considerable denial of the problem ... A substantial portion of individuals with Anorexia Nervosa have a personality disturbance that meets criteria for at least one Personality Disorder.
" In clinical practice, co-morbidity of an eating disorder and a personality disorder is a common occurrence. About 20% of all Anorexia Nervosa patients are diagnosed with one or more personality disorders (mainly Cluster C - Avoidant, Dependent, Compulsive-Obsessive - but also Cluster A - Schizoid and Paranoid).
A whopping 40% of Anorexia Nervosa/Bulimia Nervosa patients have co-morbid personality disorders (mostly Cluster B - Narcissistic, Histrionic, Antisocial, Borderline). Pure bulimics tend to have Borderline Personality Disorder. Binge eating is included in the impulsive behavior criterion for Borderline Personality Disorder.
Such rampant comorbidity raises the question whether eating disorders are not actually behavioral manifestations of underlying personality disorders. Additional resources Diagnostic and Statistical Manual of Mental Disorders, fourth edition, Text Revision (DSM-IV-TR) - Washington DC, The American Psychiatric Association, 2000 Goldman, Howard G. – Review of General Psychiatry, 4th ed. – London, Prentice-Hall International, 1995 Gelder, Michael et al., eds. – Oxford Textbook of Psychiatry, 3rd ed. – London, Oxford University Press, 2000 Vaknin, Sam – Malignant Self Love – Narcissism Revisited, 8th revised impression – Skopje and Prague, Narcissus Publications, 2006
Article Tags: Statistical Manual (dsm), Manual (dsm) Iv-tr, (dsm) Iv-tr (2000), Personality Disorders, Eating Disorders, Anorexia Nervosa, Eating Disorder, Statistical Manual, Manual (dsm), (dsm) Iv-tr, Iv-tr (2000), Personality Disorder
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ABOUT THE AUTHOR
Sam Vaknin ( http://samvak.tripod.com ) is the author of Malignant Self Love - Narcissism Revisited and After the Rain - How the West Lost the East. He served as a columnist for Central Europe Review, Global Politician, PopMatters, eBookWeb , and Bellaonline, and as a United Press International (UPI) Senior Business Correspondent. He was the editor of mental health and Central East Europe categories in The Open Directory and Suite101.
Thursday, May 21, 2009
Eating Disorders
This causes dramatic weight fluctuation, interferes with normal daily life, and damages vital body functions. An eating disorder is a compulsion to eat, or avoid eating, that negatively affects one's physical and mental health. They affect an estimated 5-7% of females in the United States during their lifetimes. Eating disorders are very complex, and despite scientific research to understand them, the biological, behavioral and social underpinnings of these illnesses remain elusive. Eating disorders are serious behavior problems.
An eating disorders are women between the ages of 12 and 25. An eating disorders involve self-critical, negative thoughts and feelings about body weight and food, and eating habits that disrupts normal body function, and daily life activities. It's common for kids - particularly teens - to be concerned about how they look and to feel self-conscious about their weight. Although eating disorders primarily affect women and girls, boys and men are also vulnerable. One in four preadolescent cases of anorexia occurs in boys, and binge-eating disorder affects females and males about equally. They include Anorexia nervosa, Bulimia nervosa and Binge-eating. Eating disorders can cause heart and kidney problems and even death.
Causes of Eating Disorders
Environmental
Psychological
Biological
Academic pressures
Genetic factors
Trauma Symptoms of Eating Disorders
significant weight loss
regularly buys laxatives
preference to eat in isolation
depression
becomes very thin
physical health complications
swollen glands in the neck and below the jaw Diagnosis for Eating Disorders
Trying to help a child who doesn't think he or she needs help can be hard. Remember that it's not your job to diagnose your child - only a doctor can do that.Treatment for Eating Disorders
Treatment can include medical supervision, nutritional counseling, and therapy. The professionals try to address a child's perception about his or her body size, shape, eating, and foods. There are a variety of treatment options available: individual therapy, group therapy, nutritional support, psychiatric care, outpatient, inpatient, residential and we can help you locate these resources. Fluoxetine and other antidepressants may reduce binge-eating episodes and help alleviate depression in some patients. Low mood may be difficult to spot in an uncommunicative teenager, and lack of interest in physical activity is not something most parents worry about in their teenage daughters. Prevention for Eating Disorders
Parents and other family members are important in helping a person see that his or her normal body shape is perfectly fine and that being excessively thin can be dangerous.
To make sure that your child knows that you love him or her for who she is and what she does, not how she looks.
By reducing or eliminating behaviors or thoughts that lead to disordered eating, and preventing relapse.
Maintaining a regular diary of eating, thoughts and feelings can be helpful.
Article Tags: Eating Disorders
Source: Free Articles from ArticlesFactory.com
ABOUT THE AUTHOR
Author Bio - Sander Bel writes articles for depression treatments. He also writes for home remedies and anxiety depression.
An eating disorders are women between the ages of 12 and 25. An eating disorders involve self-critical, negative thoughts and feelings about body weight and food, and eating habits that disrupts normal body function, and daily life activities. It's common for kids - particularly teens - to be concerned about how they look and to feel self-conscious about their weight. Although eating disorders primarily affect women and girls, boys and men are also vulnerable. One in four preadolescent cases of anorexia occurs in boys, and binge-eating disorder affects females and males about equally. They include Anorexia nervosa, Bulimia nervosa and Binge-eating. Eating disorders can cause heart and kidney problems and even death.
Causes of Eating Disorders
Environmental
Psychological
Biological
Academic pressures
Genetic factors
Trauma Symptoms of Eating Disorders
significant weight loss
regularly buys laxatives
preference to eat in isolation
depression
becomes very thin
physical health complications
swollen glands in the neck and below the jaw Diagnosis for Eating Disorders
Trying to help a child who doesn't think he or she needs help can be hard. Remember that it's not your job to diagnose your child - only a doctor can do that.Treatment for Eating Disorders
Treatment can include medical supervision, nutritional counseling, and therapy. The professionals try to address a child's perception about his or her body size, shape, eating, and foods. There are a variety of treatment options available: individual therapy, group therapy, nutritional support, psychiatric care, outpatient, inpatient, residential and we can help you locate these resources. Fluoxetine and other antidepressants may reduce binge-eating episodes and help alleviate depression in some patients. Low mood may be difficult to spot in an uncommunicative teenager, and lack of interest in physical activity is not something most parents worry about in their teenage daughters. Prevention for Eating Disorders
Parents and other family members are important in helping a person see that his or her normal body shape is perfectly fine and that being excessively thin can be dangerous.
To make sure that your child knows that you love him or her for who she is and what she does, not how she looks.
By reducing or eliminating behaviors or thoughts that lead to disordered eating, and preventing relapse.
Maintaining a regular diary of eating, thoughts and feelings can be helpful.
Article Tags: Eating Disorders
Source: Free Articles from ArticlesFactory.com
ABOUT THE AUTHOR
Author Bio - Sander Bel writes articles for depression treatments. He also writes for home remedies and anxiety depression.
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